Antifailure Therapy Including Spironolactone Improves Left Ventricular Energy Supply-Demand Relations in Nonischemic Dilated Cardiomyopathy

作者：Bell Susan P; Adkisson Douglas W; Lawson Mark A; Wang Li; Ooi Henry; Sawyer Douglas B; Kronenberg Marvin W^*

来源：Journal of the American Heart Association, 2014, 3(4): e000883.

DOI：10.1161/JAHA.114.000883

• Energy metabolism
• heart failure
• magnetic resonance imaging
• myocardial perfusion imaging
• positron emission tomography

Background-Left ventricular (LV) energy supply-demand imbalance is postulated to cause "energy starvation" and contribute to heart failure (HF) in nonischemic dilated cardiomyopathy (NIDCM). Using cardiac magnetic resonance (CMR) and [C-11] acetate positron emission tomography (PET), we evaluated LV perfusion and oxidative metabolism in NIDCM and the effects of spironolactone on LV supply-demand relations.
Methods and Results-Twelve patients with NIDCM underwent CMR and PET at baseline and after >= 6 months of spironolactone therapy added to a standard HF regimen. The myocardial perfusion reserve index (MPRI) was calculated after gadolinium injection during adenosine, as compared to rest. The monoexponential clearance rate of [C-11] acetate (k(mono)) was used to calculate the work metabolic index (WMI), an index of LV mechanical efficiency, and k(mono)/RPP (rate-pressure product), an index of energy supply/demand. At baseline, the subendocardium was hypoperfused versus the subepicardium (median MPRI, 1.63 vs. 1.80; P<0.001), but improved to 1.80 (P<0.001) after spironolactone. The WMI increased (P=0.001), as did k(mono)/RPP (P=0.003). These improvements were associated with reverse remodeling, increased LV ejection fraction, and decreases in LV mass and systolic wall stress (all P<0.002).
Conclusions-NIDCM is associated with subendocardial hypoperfusion and impaired myocardial oxidative metabolism, consistent with energy starvation. Antifailure therapy improves parameters of energy starvation and is associated with augmented LV performance.

• 出版日期2014-8